A non-invasive fibrosis score predicts treatment outcome in chronic hepatitis C virus infection.
OBJECTIVE
The results of a previous study suggest that an index calculated according to the formula (normalized ASAT x PK-INR) x 100/thrombocyte count (x 10(9)/L; GUCI) may reflect liver fibrosis in patients with chronic hepatitis C virus (HCV) infection. The aims of the present study were (i) to validate the association between the Göteborg University Cirrhosis Index (GUCI) score and liver fibrosis and (ii) to evaluate the utility of this index in predicting the outcome of antiviral treatment.


METHODS
A total of 269 patients with chronic HCV infection, stratified according to HCV genotype (1/4 versus 2/3) participated in a phase III trial using pegylated interferon alpha-2a and ribavirin (DITTO study). Retrospective analyses of the baseline GUCI scores and assessments of pretreatment liver biopsies using the Ishak protocol were performed. Cut-off GUCI scores were calculated to distinguish patients with a high or low probability of sustained viral response (SVR).


RESULTS
Striking associations between GUCI and Ishak fibrosis stages (stages 0-2 versus stages 3-4, p = 0.0002, stages 3-4 versus stages 5-6, p = 0.002) were observed. In patients with genotype 1 or 4, a GUCI score below 0.33 was associated with a rapid viral response to antiviral treatment and an SVR rate of 80%. Ninety-two percent of patients (92/101) with a SVR had a pretreatment GUCI score below 1.11.


CONCLUSIONS
Our results suggest that the GUCI score appropriately reflects the stage of liver fibrosis in HCV-infected patients, and predicts initial viral kinetics as well as treatment outcome in patients infected with HCV genotype 1 or 4.
Westin
Johan
J
Department of Infectious Diseases, Göteborg University, Sweden. johan.westin@infect.gu.se
Ydreborg
Magdalena
M
Islam
Sara
S
Alsiö
Asa
A
Dhillon
Amar P
AP
Pawlotsky
Jean-Michel
JM
Zeuzem
Stefan
S
Schalm
Solko W
SW
Ferrari
Carlo
C
Neumann
Avidan U
AU
Hellstrand
Kristoffer
K
Lagging
Martin
M
D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin